Amaraso ava munda, Indwara yo kuva amaraso ku bananura amaraso, hamwe no gutandukana¶

Indwara ya spontaneous intracerebral (ICH) ni hyperacute neurosurgical na neurologiya yihutirwa aho imiyoboro y'amaraso itobora iturika imbere mubwonko bwubwonko (parenchyma), isuka amaraso mumitsi ikomeye ya gihanga. Nubwo indwara yo kuva amaraso ihwanye na 15 kugeza kuri 20 ku ijana byubwonko bwose, bitera hafi kimwe cya kabiri cyimpfu zose zatewe nubwonko kandi bikaguka byihuse, bikabije mugihe cyamasaha 1 kugeza kuri 3 nyuma yo gutangira. Niba umuntu agize ibimenyetso bitunguranye byubwonko (isura yubusa, intege nke zamaboko, cyangwa guta ijambo) biherekejwe no kubabara umutwe cyane, kuruka, umuvuduko ukabije wamaraso, cyangwa kugabanuka kugabanuka vuba, hamagara aho utuye nimero yihutirwa ako kanya. Mugihe utegereje inkeragutabara, subiramo protocole yihutirwa kuri kumenyekanisha ubwonko (FAST), subarachnoid kuva amaraso no kubabara umutwe, na anticoagulant ihinduka no kuva amaraso.

Kuberako mililitiro yamaraso ihungira mubwonko ishenjagura miriyoni ya neuron kandi igatera umuvuduko wimitsi itera ubwonko bwica ubwonko, kubaho mbere yibitaro biterwa nibintu bitatu bikaze: ** ntuzigera utanga aspirine cyangwa ikintu icyo ari cyo cyose cyangiza amaraso mbere yibitaro CT scan **, birinda inzira yumuyaga kuruka mugihe uzamuye umutwe wuburwayi bwa dogiteri hamwe nitsinda ryihutirwa rya ** apixaban, rivaroxaban, edoxaban, cyangwa dabigatran) bityo antidote yimitsi ihindagurika irashobora gutegurwa mbere yuko ambulance ihagera.

Kora ubu¶

1. ** Hamagara nimero yawe yihutirwa ako kanya hanyuma ukore Alert. nimero yihutirwa. Bwira abohereje neza: * "Gukekwaho indwara yo kuva amaraso: ubumuga butunguranye no kuvuga nabi no kubabara umutwe no kuruka." *
2. ** NTUKIGERE utanga aspirine, clopidogrel, ibuprofen, cyangwa ikindi kintu cyose cyongera amaraso. Guha n'umuti umwe wa aspirine kumurwayi ufite amaraso ava munda ahagarika burundu platine yamaraso kandi byihutisha kwaguka kwa hematoma yica mubwonko.
3. ** Menya buri kintu cyoroha mumaraso (anticoagulant cyangwa antiplatelet) umurwayi afata nigihe nyacyo cyisaha yumuti wanyuma. ** enoxaparin ** (Lovenox / Clexane), cyangwa ** clopidogrel ** (Plavix). Gira radiyo inkeragutabara izina nyaryo ryibiyobyabwenge nisaha yanyuma yanyuma kubitaro byakira mbere yuko uhagera kugirango farumasi ibashe kuvanga antidote yihariye yo mu mitsi (** 4-Factor Prothrombin Complex Concentrate [4F-PCC], Andexanet alfa, cyangwa Idarucizumab **) kugirango uhite winjira ("Code ICH").
4. ** Shyira umurwayi n'umutwe hamwe n'umubiri wo hejuru wazamutseho dogere 30, ugumisha ijosi kugororoka hagati (cyangwa kuzunguruka kuruhande rwabo niba kuruka cyangwa kutagira ubwenge). Ariko, niba umuntu atangiye kuruka cyangwa guta ubwenge, hita ubizunguruka mumwanya wa ** wo gukira kuruhande ** kuruhande kugirango kuruka bidashobora guhumeka mubihaha.
5. ** Reba umuvuduko wamaraso murugo niba uhita uboneka, ariko NTUKIGERE utanga ibinini byongera umuvuduko wamaraso munsi yururimi cyangwa umunwa. ** Bwira inkeragutabara gusoma umuvuduko wamaraso. Nubwo umuvuduko wamaraso wa systolique ukunze kuzamuka hejuru ya mm 180 kugeza kuri 220 mmHg mugihe cyo kuva amaraso mu bwonko, kumira ibinini byumuvuduko wamaraso bitera ibyago byo kuniga kumurwayi wubwonko kandi bigatera impanuka itagenzuwe, idahwitse kumuvuduko wubwonko. Inkeragutabara n’abaganga byihutirwa bakoresha ibikorwa-bigufi, byitirirwa neza byinjizwamo imitsi (nka nicardipine, clevidipine, cyangwa labetalol) kugirango bagabanye umuvuduko wamaraso wa systolike neza kugeza kuri ** 130 kugeza 150 mmHg **.
6. ** Komeza umurwayi nil kumunwa (ntakintu cyo kurya, kunywa, cyangwa kumira) hanyuma wandike igihe "Cyiza kizwi". ** Ntutange amazi, umutobe, cyangwa imiti yo munwa. Andika ibimenyetso nyabyo umunota watangiye (cyangwa ubushize umuntu yabonetse bisanzwe).

Igiti cyemezo: inkorora ikaze hamwe no gukekwa kuva amaraso ava munda cyangwa gukoresha amaraso¶

flowchart TD
    Start["Gutungurwa kwa Neurologiya Bitunguranye (VUBA: Kugabanuka mu maso, Intege nke zamaboko, gutakaza imvugo) CYANGWA Kubabara umutwe gitunguranye, kuruka, urujijo, cyangwa koma"] --> CallEMS["1. Hamagara Serivise Yihutirwa (911/112/999) Ako kanya: Koresha Alert"]

    CallEMS --> NoAspirin["2. AMATEGEKO AKOMEYE: NTUKIGERE Uha Aspirin, Ibuprofen, cyangwa imiti iyo ari yo yose yo mu kanwa"]

    NoAspirin --> AirwayCheck{"3. Ese umurwayi aruka, aratemba, cyangwa arasinzira cyangwa nta ubwenge?"}

    AirwayCheck -->|"YEGO: Kuruka cyangwa Kugabanuka Kumutima (GCS munsi ya 9)"| Recovery["Kuzunguruka Ako kanya Mumwanya wo Kugarura (Umutwe Ushyigikiwe): Umunwa usukuye kuruka, umukufi urekuye, ukurikirane guhumeka neza kuri Cushing triad"]

    AirwayCheck -->|"OYA: Kanguka, ube maso, kandi ntugire isesemi"| Elevate30["Kuzamura Umutwe na Torso yo hejuru Impamyabumenyi 30: Komeza umutwe nijosi bigororotse neza hagati (ntukande imitsi ya jugular)"]

    Recovery --> BloodThinner{"4. Ese umurwayi afata amaraso yanduye (anticoagulant)?"}
    Elevate30 --> BloodThinner

    BloodThinner -->|"YEGO: Warfarin, Apixaban, Rivaroxaban, Edoxaban, Dabigatran, cyangwa Heparin"| CodeICH["IBITARO BY'IBANZE KUBERA KODE ICH ANTICOAGULANT REVERSAL: Menyesha izina ryibiyobyabwenge, imbaraga za miligarama, nisaha nyayo yisaha yanyuma"]

    BloodThinner -->|"OYA cyangwa Ntazwi"| HospitalCT["5. Ubwikorezi bwihuse bwikigo cyubwonko bwihuse CT: Kurikirana BP, genzura glucose yamaraso yintoki, komeza NPO"]

    CodeICH --> Antidotes["Bundle y'ibitaro Mu minota 30 kugeza kuri 60 yo kugera ku rugi: Warfarin ibona 4F-PCC + IV Vitamine K; Apixaban / Rivaroxaban ibona Andexanet alfa cyangwa 4F-PCC; Dabigatran abona Idarucizumab; Byoroheje IV BP kumanuka kuri SBP 130-150 mmHg"]

Pathophysiology: burya amaraso ava munda araguka kandi akajanjagura ubwonko¶

Bitandukanye n'indwara ya ischemic (aho amaraso atobora imiyoboro y'ubwonko kandi ikicisha inzara inyama zo mu bwonko bwa ogisijeni) cyangwa a subarachnoid hemorhage .

1.¶

Indwara ebyiri zitandukanye zishingiye ku mitsi itera hejuru ya 80 ku ijana by'amaraso ava mu nda:

• ** Indwara ya Hypertensive Microangiopathie (Amaraso Yimbitse): ** Imyaka yumuvuduko ukabije wamaraso utagengwa na batteri ntoya, yoroheje umusatsi utobora imitsi (lenticulostriate, thalamoperforating, na paramedian basilar ishami) ishami rihita rihuza imiyoboro minini yumuvuduko ukabije wubwonko bwa dogere 90 kugirango igaburire imiterere yimbitse yubwonko. Igihe kirenze, inkuta zimitsi yiyi mikorosikopi yangirika (lipohyalinose) na ballon ihinduka byoroshye ** Charcot-Bouchard microaneurysms **. Mugihe umuvuduko ukabije wumuvuduko wamaraso, kimwe muribi bikoresho byimbitse cyacitse imbere muri ** basal ganglia (putamen) **, ** thalamus **, ** cerebellum **, cyangwa ** pons **.
• ** Cerebral Amyloid Angiopathie (CAA - Amaraso ya Lobar mu Bakuru Bakuru): ** Ku bantu bakuze barengeje imyaka 60 kugeza kuri 65 (ndetse n'abafite umuvuduko ukabije w'amaraso usanzwe), beta-amyloide proteine ​​ibika imbere y'urukuta rw'imitsi mito n'iciriritse mu bwonko bwo hanze ndetse na leptomeninges, bigatuma imiyoboro imeneka nk'ikirahure gishaje. Iyo ibyo bikoresho byo hejuru bisatuye, bitera amaraso manini ya ** lobar ** imbere, parietal, by'agateganyo, cyangwa ocipital lobes.

2. Inyigisho ya Monro-Kellie hamwe na moderi ya avalanche yo kwaguka kwa hematoma¶

Igihanga cy'umuntu ukuze ni ikidodo gifunze, gikomeye kandi gifite amagufwa yimbere afite hafi ya milimetero ** 1,400 kugeza kuri 1.700 mililitiro **, igabanijwemo ibice bitatu bidashoboka: ** ubwonko bwubwonko (80 ku ijana) **, ** ubwonko bwubwonko (10 ku ijana) **, na ** maraso yimitsi (10 ku ijana) **. Dukurikije inyigisho ya ** Monro-Kellie **, kubera ko igihanga kidashobora kwaguka, misa iyo ari yo yose yongewemo imbere muri cranium (nk'ikidendezi cyagutse cy'amaraso ya arterial) igomba guhita yimura amazi ya cerebrospinal n'amaraso y'amaraso; iyo utwo tuntu duto tumaze kunanirwa (mubisanzwe nyuma ya mililitiro 50 kugeza kuri 80 z'ubunini bwa hematoma, kandi nka mililitiro 20 kugeza kuri 30 muri fossa ifatanye inyuma ya cerebellum), ** umuvuduko w'imbere (ICP) ikirere cyinshi cyane **.

Ikirushijeho kuba kibi, kuva amaraso ava munda ntabwo ari ikintu kimwe gusa. Ubushakashatsi bwa Neuroimaging bwerekana ko ** kwaguka kwa hematoma ikora ** bibaho mugihe cyambere cya ** 1 kugeza kuri 6 ** (no kumasaha agera kuri 24 kubarwayi bangiza amaraso) binyuze kuri ** Fisher "avalanche" ** ** "Ikimenyetso cy'ahantu" **). Buri ** kwiyongera 10 ku ijana mubunini bwa hematoma ** byongera cyane amahirwe yo gupfa cyangwa ubumuga bukabije.

3. Ubwonko bwa herniation hamwe na Cushing triad¶

Nkuko kwaguka kwamaraso no kubyimba bikikije (edema ya perihematomal) bisunika ubwonko bwanduye bwangiritse kuruhande rwagati rwagati (** midline shift ) hanyuma ukamanuka unyuze mucyumba gito cyamahema munsi yigitereko cya gihanga ( unal cyangwa transtentorial herniation **), ubwonko burajanjagurwa. Shakisha ibimenyetso bitinze byamavuriro byerekana ubwonko bwegereje:

1. ** Umunyeshuri "uhuhuta" (Mydriasis Unilateral): ** Kwiyongera kwamaraso gukanda kanda lobe yigihe gito (uncus) kurwanya ** nervice ya gatatu ya cranial nervée (oculomotor nerv) **, bigatuma umunyeshuri kuruhande rwa ** kimwe n'ubwonko buva amaraso ** kugirango buguruke kandi buhagarike kugabanuka mugihe itara ryaka.
2. ** Cushing Triad (Terminal intracranial pressure reflex): ** Iyo umuvuduko ukabije wimbere mu gihanga uniga amaraso atembera mubwonko, ubwonko butera ubwuzu bukabije bwimpuhwe zo guhatira amaraso mumutwe, bigatuma habaho impinduka eshatu za physiologique:
3. ** Kwaguka gukabije k'umuvuduko wa pulse hamwe na hypertension systolike ya skystocking ** (urugero, umuvuduko w'amaraso usimbuka kuri 240/90 mmHg).
4. ** Reflex bradycardia ** (umuvuduko wumutima udasanzwe, kugabanuka kugera kuri 40 kugeza kuri 50 kumunota nubwo habaye ikibazo).
5. ** Guhumeka bidasanzwe, guhumeka, cyangwa guhagarika ubuhumekero ** (Cheyne-Stoke cyangwa Biot guhumeka).
6. ** Gutandukanya cyangwa kwifata neza: ** Guhindagurika gukabije kwamaboko yerekeza mu gituza (decorticate) cyangwa kugorora gukomeye no kuzenguruka imbere imbere y'amaboko n'amaguru byombi hamwe nijosi ryiziritse (decerebrate).

Gutandukanya indwara ya hemorhagie (ICH), ischemic stroke, na subarachnoid hemorhage¶

Nubwo ibitaro bya CT byonyine bishobora gutandukanya ubwonko bwamaraso nubwonko bwifata, ibimenyetso byinshi biranga amavuriro kumuriri yigitanda byerekana cyane kumaraso ** yo mu nda ** akakuburira ko umurwayi ashobora kwangirika muri koma muminota mike:

Imikono yihariye yihariye: ibibanza 5 bya anatomiki ya classique yo kuva amaraso ava munda¶

Abaganga byihutirwa naba psychologue barashobora gukuramo imiyoboro nyayo yimbitse mbere yuko umurwayi yinjira muri CT scaneri yitegereza ** uburyo amaso asa ** nuburyo umubiri ugenda:

Anticoagulant ifitanye isano no kuva amaraso ("Code ICH" reversion triage)¶

Hafi ya ** 15 kugeza kuri 20 ku ijana by'amaraso yose yo mu nda ** aboneka ku barwayi bafata imiti ** anticoagulants yo mu kanwa ** ya fibrillation atriyale, trombose ndende, imitsi ya embolisme, cyangwa imitima yumutima. Mugihe ubwonko bwihuse bwamaraso kumurwayi ufite imyambarire isanzwe akenshi ihagarika kwaguka nyuma yamasaha 3 kugeza kuri 6, ubwonko buva amaraso kuri ** warfarin, apixaban, rivaroxaban, edoxaban, cyangwa dabigatran ** ikomeza gusuka amaraso mubwonko kumasaha ** 12 kugeza 24% **, bitwaye ** 40 kugeza 60% byimpanuka ** yibitaro **

Gucunga umuvuduko wamaraso mugutembera kwa interacerebral: kuki kugabanuka kwa IV kugabanuka kurokora ubuzima¶

Ibice birenga 75 kw'ijana by'abarwayi bafite amaraso akomeye yo mu nda aboneka bafite umuvuduko w'amaraso wa sisitemu uri hejuru ya ** 180 kugeza 240 mmHg . Mugihe umuvuduko wa systolique ukomeje kuba mwinshi, imiyoboro yamenetse ihatira amaraso menshi mumyanya ya hematoma. Ibigeragezo byingenzi byamavuriro ( INTERACT2, ATACH-2, na INTERACT3 **) hamwe nubuyobozi bwa ** 2022 AHA / ASA ** bushiraho amategeko atatu yibanze:

1. ** Ntuzigere utanga ibinini byamaraso cyangwa umunwa murugo: ** Ntutange ibinini byinyongera murugo amlodipine, lisinopril, metoprolol, clonidine, cyangwa nifedipine. Kimwe cya kabiri cy'abarwayi bose ba ICH bafite ubumuga bwo kumira (** dysphagia **) cyangwa kuruka, guhura n'ikibazo cyo kuniga cyangwa kwifuza, kandi ibinini byo mu kanwa birashobora gutera impanuka itagenzuwe n'umuvuduko w'amaraso wicisha inzara ubwonko.
2. ** Intego yibitaro kuri ICH yoroheje-igereranije (yerekana SBP 150 kugeza kuri 220 mmHg): ** Abaganga batangira igitonyanga gikomeza, ultra-bigufi-gikora imitsi ya arterial vasodilator itonyanga (** nicardipine, clevidipine, labetalol, cyangwa urapidil **) mugihe cyisaha 1 yo kugera kuri ** umuvuduko ukabije wa mm 180Hg.
3. ** Irinde kugabanya umuvuduko wamaraso wa systolique uri munsi ya 130 mmHg: ** Ikigeragezo cya ATACH-2 cyerekanye ko gusunika umuvuduko wamaraso wa systolike munsi ya ** 130 mmHg ** bitagabanya amaraso kandi bikongera ibikomere bikabije byimpyiko na ischemia yubwonko.

Intambwe ku yindi ubuvuzi bwa prehospital mugihe utegereje ambulance¶

1. ** Umwanya uhagaze (amategeko ya dogere 30 nu mwanya wo gukira): ** Niba umurwayi akangutse kandi NTIBIRUKA, shyira umugongo wo hejuru hanyuma werekeza hejuru ya dogere 30 ya dogere ** hamwe na ** umutwe n ijosi bigororotse neza hagati ya ** hanyuma urekure amakariso akomeye (kugoreka ijosi bikubita imitsi yimbere kandi bizamura umuvuduko wimitsi). Niba umurwayi arimo kuruka, gutontoma, cyangwa gusinzira / kutagira ubwenge, ubizungurize ako kanya kuruhande rwabo mumwanya wa ** wo gukira kuruhande ** bityo kuruka biva mumunwa.
2. ** Irinde Valsalva kunaniza no gucunga igicuri: ** Komeza icyumba utuje kandi utuje. Amaraso ya Cortical (lobar) atera gufatwa muri rusange mugitangira abarwayi 8 kugeza 15%; niba igicuri kibaye, shyira umutwe, uzunguze umuntu kuruhande (reba yafashe ubufasha bwambere), kandi ntuzigere ushyira ibintu mumunwa.
3. ** Irinde umuriro kandi urebe glucose yamaraso: ** Buri ** dogere selisiyusi 1 (dogere 1.8 Fahrenheit) izamuka ryubushyuhe ** bikabije kubyimba ubwonko, bityo rero ukureho ibiringiti biremereye. Inkeragutabara zizasuzuma isukari yamaraso yintoki ako kanya kugirango hirindwe hypoglycemia (<3.3 mmol/L cyangwa 60 mg/dL).

Ibitaro bya neurosurgical na neuro-ICU¶

Iyo umutwe utandukanye na CT scan wemeza ko amaraso ava munda kandi apima ubunini bwayo (ukoresheje formula ya ** ABC / 2 **: uburebure A ubugari B inshuro ukata umubyimba C bigabanijwe na 2), itsinda rya stroke na neurosurgie team ritangiza ** INTERACT3 Intego-Yita ku Buvuzi Bundle **:

1. ** Anticoagulant ihindagurika kandi yoroheje umuvuduko wamaraso wa IV ugabanuka ** muminota 30 kugeza 60.
2. ** Imiyoboro ya Ventricular Drain (EVD) yo kuva amaraso ava mu mitsi (IVH): ** Iyo amaraso yamenetse mumashanyarazi kandi akabuza imiyoboro y'amazi ya cerebrospinal (** obstructive hydrocephalus **), neurosurgueons ashyira catheter ya ventriculostomy kugirango akure amazi kandi akurikirane umuvuduko w'amaraso.
3. ** Kwimura imyenda yo kubaga: ** Ako kanya ** suboccipital craniectomy ** irokora ubuzima kumaraso ya cerebellar arenga mililitiro 15 (cyangwa diameter >3 cm.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Abarwayi bafite ikibazo cyo kuva amaraso munda basaba gutwara ambulance itaziguye ku kigo cyemewe cya ** Comprehensive Stroke Centre (CSC) ** cyangwa ibitaro bifite CT scan yamasaha 24, anticoagulant reversal antidote, hamwe nubushobozi bwa neurosurgical / neuro-ICU:

• ** Amerika na Kanada: ** Hamagara ** 911 **. Inkeragutabara za EMS zikoresha umunzani ukabije w’ibitaro (nk'AMOKO, INTAMBWE, cyangwa C-STAT) hanyuma ukabimenyesha mbere ikigo cyakira Stoke kugirango scaneri ya CT isukure mbere yuko umurambararo ugera.
• ** Ubwongereza: ** Hamagara ** 999 **. Munsi ya ** NHS na NICE Guideline NG128 (Igitero cya Stoke na Transche Ischemic Attack on over 16s) ** hamwe na ** National National Stroke Guideline (2023 Edition) **, abarwayi ba ICH bakira ** "ABC Care Bundle" ** (Rapid ** A ** nticoagulant ihinduka muminota 60, Umuvuduko ukabije wa ** B ** ugabanuka kugera kuri 130-140 mmHg.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi: ** Hamagara ** 112 **. Kurikiza ** Umuryango w’ibihugu by’i Burayi (ESO) ** amabwiriza utanga imiti yose yo mu kanwa (VKAs cyangwa DOACs) ako kanya kubohereza byihutirwa.
• ** Australiya na Nouvelle-Zélande: ** Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande. Gucungwa munsi ya ** Fondasiyo ya Australiya (Australiya / NZ) Amabwiriza Yubuzima Yubuzima bwo Kurwara Indwara **.
• ** Ubuhinde na Aziya-Pasifika: ** Hamagara ** 112 ** (cyangwa ** 108 ** mu Buhinde), ** 995 ** muri Singapuru, ** 119 ** mu Buyapani na Koreya y'Epfo, cyangwa ** 999 ** muri Maleziya na Hong Kong. Saba ubwikorezi mubitaro bya kaminuza bifite amasaha 24 CT na neurosurgie.

Ibibazo bikunze kubazwa¶

Kuki ntashobora guha aspirine umuntu ufite ubwonko nkawe kubitera umutima?¶

Mu gihe indwara z'umutima hafi ya zose ziterwa no gutembera kw'amaraso ya platine imbere mu mitsi y'amaraso, hafi 15 kugeza kuri 20 ku ijana by'imitsi yose ni indwara yo kuva amaraso iterwa no guturika kw'amaraso ava mu bwonko. Kubera ko ischemic (clot) zombi hamwe na hemorhagie (kuva amaraso) bitera ibimenyetso bitunguranye nko gutemba mumaso, kumugara ukuboko, no kuvuga nabi, ntibishoboka ko umuntu yizera 100% murugo ubwoko bubera. Guha aspirine kumuntu ufite ikibazo cyo kuva amaraso guhagarika burundu imitsi ya platine kandi byihutisha kuva amaraso yica imbere muri gihanga. Ntuzigere utanga aspirine kugeza ibitaro CT scan byerekana ko nta maraso.

Nigute ushobora gukeka ko ubwonko bushobora kuba amaraso mu bwonko aho kuba amaraso?¶

Nubwo ibitaro bya CT byonyine bishobora kwerekana ko byasuzumwe, kuva amaraso munda yo mu nda birashoboka cyane mugihe ibimenyetso byubwonko butunguranye (intege nke kuruhande rumwe, kubura kuvuga, cyangwa kubura iyerekwa) biherekejwe no kubabara umutwe gitunguranye, isesemi no kuruka bikabije, umuvuduko ukabije wamaraso (akenshi urenga 180 kugeza kuri 220 mmHg), gufatwa mugitangira, cyangwa kugabanuka neza, iminota 15,

Ni ukubera iki byihutirwa kubwira inkeragutabara izina nyaryo nigihe cyanyuma cyo kumena amaraso?¶

Kuva amaraso mu bwonko ku barwayi bafata amaraso (warfarin, apixaban, rivaroxaban, edoxaban, cyangwa dabigatran) yaguka vuba mu masaha 12 kugeza kuri 24 kandi bitwara impfu zingana na 40 kugeza kuri 60 ku ijana keretse bihindutse ako kanya. Ibyiciro bitandukanye byo kunanura amaraso bisaba imiti igabanya ubukana butandukanye mubitaro (4-Factor PCC na Vitamine K ya warfarin; Andexanet alfa cyangwa 4F-PCC kuri apixaban na rivaroxaban; Idarucizumab kuri dabigatran), kandi ikigereranyo cya Andexanet alfa cyaterwaga cyane na miligramu ya aligana. Mbere yo kumenyesha ibitaro byemerera farumasi gutegura antidote mbere yuko ambulance ihagera.

Nakagombye guha umurwayi wubwonko urugero rwinshi rwimiti yumuvuduko wamaraso murugo niba umuvuduko wamaraso ari 210/110 mmHg?¶

Oya, ntuzigere uha ibinini byumuvuduko wamaraso kumunwa cyangwa sublingual kumuntu ufite ikibazo cyubwonko. Ubwa mbere, inkorora ikunze guhagarika imitsi yo mu muhogo isabwa kumira neza, bigatera ibyago byihuse byo kuniga cyangwa guhumeka ibinini mu bihaha. Icya kabiri, imiti yo mu kanwa igabanya umuvuduko wamaraso utateganijwe kandi ntishobora kuzimwa niba umuvuduko wamaraso ugabanutse cyane, ushobora kwicisha inzara ubwonko bwabyimbye bwamaraso. Abaganga b'ibitaro bagabanya umuvuduko w'amaraso neza kugera kuri mm 130 kugeza kuri 150 mmHg bakoresheje imitsi ikomeza, ikora igihe gito.

Kuki ubwonko bwubwonko buva amaraso kenshi bikamenyekana nabi nkikibazo cyamatwi yimbere cyangwa uburozi bwibiryo?¶

Kubera ko ubwonko bugenzura uburinganire no guhuza imbaraga aho kuba imbaraga zamaboko cyangwa mumaso, kuva amaraso mu bwonko bitera kuzunguruka gitunguranye (vertigo), isesemi ikabije no kuruka, no kubabara umutwe inyuma yumutwe bidateye kunanuka mumaso cyangwa kumugara. Ibendera ryumutuku ryingenzi ritandukanya ubwonko bwubwonko na virusi yo mumatwi yimbere ni truncal ataxia: umurwayi ntashobora rwose kwicara, guhagarara, cyangwa kugenda intambwe imwe ataguye. Kumenyekanisha ibitaro hakiri kare bituma ubuzima burokora ubuzima bwo kubaga mbere yo kubyimba ubwonko bwabyimbye.

Kuki umutwe wigitanda ugomba kuzamurwa dogere 30 hamwe nijosi rigororotse mubwonko?¶

Mu murwayi ukangutse udasimba, uzunguza umutwe n'ibitugu hejuru ya dogere 30 hamwe n'umutwe ureba imbere ugana imbere bikoresha imbaraga zifasha gutembera kw'amaraso ava mu gihanga binyuze mu mitsi y'imbere, bigabanya umuvuduko w'amaraso utagabanya umuvuduko w'amaraso mu bwonko. Kugumisha ijosi neza birinda gukubita imitsi. Ariko, niba umurwayi arimo kuruka cyangwa kutagira ubwenge, bagomba gushyirwa kuruhande rwabo kugirango bakire kugirango barinde inzira zabo.

Inkomoko nubuyobozi¶

• ** Ishyirahamwe ry’umutima w’abanyamerika / Ishyirahamwe ry’Abanyamerika (AHA / ASA, Amerika): ** * 2022 Amabwiriza agenga imiyoborere y’abarwayi bafite indwara yo kuva amaraso mu buryo bwihuse * (Greenberg n'abandi.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi (ESO, Uburayi): ** * Amabwiriza y’umuryango w’ibihugu by’i Burayi ku bijyanye n’imicungire y’imisemburo ya Spontaneous Intracerebral * na * Anticoagulant-Associated Intracerebral Haemorrhage *.
• ** Ikigo cy'igihugu gishinzwe ubuzima no kwita ku ndashyikirwa (NICE) & Ishyaka Riharanira Gukora Intercollegiate Stroke (Ubwongereza): ** * Igitero cy’indwara ya Ischemic n’inzibacyuho mu myaka irenga 16: Gusuzuma no Gucunga Intangiriro (NG128) * na * Amabwiriza y’ubuvuzi y’ubuvuzi bw’Ubwongereza na Irilande (2023) * ("ABC" ICH care bundle).
• ** Iperereza rya INTERACT3 (Ma L, Hu X, Indirimbo L, n'abandi., * The Lancet *, 2023): **
• ** Ihuriro mpuzamahanga ry’umuryango utabara imbabare Croix-Rouge n’umuryango utabara imbabare (IFRC) & Komite ya Ositaraliya na Nouvelle-Zélande ishinzwe gutabara (ANZCOR): ** * Imfashanyo mpuzamahanga ya mbere, Inkeragutabara, n’Amabwiriza y’uburezi: Kumenya indwara y’indwara no kwita ku bitaro *.

Kuyobora¶

• Kumenyekanisha inkorora (FAST) nubufasha bwambere
• Subarachnoid kuva amaraso, kubabara umutwe, no guturika aneurysm
• Amaraso yangiza ubuzima kumeneka yamaraso cyangwa muri hemofilia
• Igitero cyigihe gito (TIA / mini-stroke) hamwe nimpanuka zamasaha 24
• Ikibazo cya hypertension, hypertension malignant, n'umuvuduko w'amaraso hejuru ya 180/120